title: Impact of ileostomy-related complications on the multidisciplinary treatment of rectal cancer.
abstract: BACKGROUND
  Radical resection is the primary treatment for rectal cancer. When anastomosis is possible, a temporary ileostomy is used to decrease morbidity from a poorly healed anastomosis. However, ileostomies are associated with complications, dehydration, and need for a second operation. We sought to evaluate the impact of ileostomy-related complications on the treatment of rectal cancer.
  
  
  METHODS
  We conducted a retrospective study of patients who underwent sphincter-preserving surgery between January 2005 and December 2010 at a tertiary cancer center. The primary outcome was the overall rate of ileostomy-related complications. Secondary outcomes included complications related to ileostomy status, ileostomy closure, anastomotic complications at primary resection, rate of stoma closure, and completion of adjuvant chemotherapy assessed by multivariate logistic regression.
  
  
  RESULTS
  Of 294 patients analyzed, 32% (n = 95) were women. Two hundred seventy-one (92%) received neoadjuvant chemoradiation. The median tumor distance from the anal verge was 7 cm (interquartile range 5-10 cm). Two hundred eighty-one (96%) underwent stoma closure at a median of 7 months (interquartile range 5.4-8.3 months). The most common complication related to readmission was dehydration (n = 32-11%). Readmission within 60 days of primary resection was associated with delay in initiating adjuvant chemotherapy (odds ratio 3.01, 95% confidence interval 1.42-6.38, p = 0.004).
  
  
  CONCLUSIONS
  Diverting ileostomies created during surgical treatment of rectal cancers are associated with morbidity; however, this is balanced against the risk of anastomosis-related morbidity at rectal resection. Given the potential benefit of fecal diversion, patient-oriented interventions to improve ostomy management, particularly during adjuvant chemotherapy, can be expected to yield marked benefits.
authors.affiliation: Department of General Surgery, The University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Uma R
authors.initials: UR
authors.lastname: Phatak
authors.forename: Lillian S
authors.initials: LS
authors.lastname: Kao
authors.forename: Y Nancy
authors.initials: YN
authors.lastname: You
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Rodriguez-Bigas
authors.forename: John M
authors.initials: JM
authors.lastname: Skibber
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
authors.forename: Sa
authors.initials: S
authors.lastname: Nguyen
authors.forename: Scott B
authors.initials: SB
authors.lastname: Cantor
authors.forename: George J
authors.initials: GJ
authors.lastname: Chang
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies